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Pelosi Faces Competing Pressures on Health Care

WASHINGTON — As House Democratic leaders were assembling their health care bill last month, Speaker Nancy Pelosi left Washington on a political fund-raising tour.

Accompanying her on the US Airways flight to her first stop, Cleveland on Oct. 2, was a prominent health care lobbyist, Frederick H. Graefe, who represents hospitals, medical equipment companies, a few drug companies and others in the industry.

Mr. Graefe had helped enlist some of the half-dozen health industry executives attending a fund-raising dinner that night. All oppose what Ms. Pelosi and many other House Democrats were calling for as the centerpiece of a health care overhaul: a muscular government-run insurer, with the power to push down fees.

But the host of the event, which brought in nearly $100,000 for the Democratic Congressional Campaign Committee from about 40 donors, was Stuart I. Garson, a trial lawyer who wants the overhaul to crack down on soaring health care costs and profiteering insurance companies, as he put it in an interview. And the other guests were mostly left-leaning Cleveland-area legislators who consider any bill without a so-called public option to be a sellout.

It was a microcosm of the political pressures facing Ms. Pelosi as she tries to steer the health care overhaul through the House, which could vote on its bill as early as Saturday, and then in a conference with the more conservative Senate. Her party’s liberal base and most House Democrats are demanding that she fight for their priorities, including both a government insurer and a squeeze on drug industry profits.

But Ms. Pelosi was traveling to raise money, as she does almost every weekend, in part because she is determined to help re-elect her most vulnerable members, many from Republican-leaning districts leery of liberal health care proposals.

And most health industry lobbyists, who have increased their contributions in an effort to maintain their access to her, are betting that behind the closed doors of the conference, she will yield to the Senate, which has so far resisted the public option and honored a political deal limiting the drug industry’s costs in an overhaul to $80 billion over 10 years.

“I don’t think she is faking it, because she will try to get the outcome most reflective of the House,” said Representative Earl Pomeroy, a North Dakota Democrat who recently switched to support the bill, in part in expectation that it would return from the conference more conservative. “But the speaker has displayed a tough-minded pragmatism when it comes to rounding up votes, and she is not going to negotiate with the Senate on the basis of ‘This is the House bill — take it or leave it.’ ”

House liberals say such accommodation is what they fear. “We have already compromised some of the agenda, and the leaders rationalize that by saying, ‘This is the best we could do,’ ” complained Representative Raúl M. Grijalva, an Arizona Democrat who is co-chairman of the Congressional Progressive Caucus.

And his party’s raising money from the health care industry, he said, only worries him more. “Their lobbying pressure around here is already at a maximum,” he said, “so to have them that much in the nest in terms of fund-raising only adds to the concern.”

A spokesman for Ms. Pelosi said her role as House Democrats’ chief fund-raiser had no effect on her work as speaker. The House bill shows that “the speaker has put consumers first and taken a tough position against the insurance and drug industries,” said the spokesman, Nadeam Elshami.

Photo

Speaker Nancy Pelosi fund-raises most weekends, as at this Miami event last month for Democratic candidates for the House and the Senate.Credit
Doug Mills/The New York Times

But industry lobbyists, speaking on condition of anonymity for fear of alienating Ms. Pelosi, say they have stepped up their fund-raising for her all year with an eye to her pivotal role in the health care endgame, hoping to stay in her good graces and glean insights into her thinking.

Individuals connected to the industry have already given $210,000 to her campaign fund this year, according to data from the Center for Responsive Politics, compared with a total of $280,000 in the two years before the 2008 election, $87,000 in the two years before the 2006 election, and less than $50,000 in any cycle before that.

Ms. Pelosi has courted health care lobbyists. At an April 28 breakfast, she collected five checks for a total of $18,000 from groups representing for-profit hospitals, radiologists, internists and gynecologists. She has collected $10,000 checks from political action committees representing not only for-profit hospitals but also nurses; cardiologists; Medco, a drug benefit manager; and the drug makers Amgen and Johnson & Johnson.

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She has often accepted donations from people whom she and other Democrats vilify as opponents of reform. She has taken several checks from insurance industry lobbyists, for example, including $1,000 from Karen Ignagni and $1,500 from Mary Beth Donahue, both of the industry’s trade group.

At the end of September, shortly before her trip to Cleveland, Ms. Pelosi flew to the Austin, Tex., home of the Democratic lobbyist Ben Barnes to collect more than $125,000 for the Democratic Congressional Campaign Committee from doctors at physician-owned hospitals.

Mr. Barnes, who personally gave $30,000 to the committee, represents several physician-owned hospitals, which Ms. Pelosi and many Democrats have pilloried for giving doctors a financial incentive to order expensive treatments for their patients.

Meanwhile, back in Washington, Bryant Hall, a top lobbyist for the drug industry, was giving $1,000 to the Democrats’ campaign committee, and many lobbyists were attending an annual dinner for the campaign committee featuring the chiefs of staff of several top lawmakers, including Ms. Pelosi. (From Cleveland, the speaker herself went on to hold similar fund-raisers in Detroit and St. Louis.)

Now, with the two houses moving to vote on very different health care bills, Ms. Pelosi is poised to face off against the Senate and the White House on several elements that divide the Democrats and arouse big donors. Beyond the fight for the public option, she has vowed to oppose the Senate and the administration on two favorite ideas of fiscal conservatives.

One is a proposed independent commission to rein in Medicare spending, an approach that House lawmakers resent as an intrusion on their turf and health care providers fear as a threat to their income. The other is a proposed tax on expensive insurance plans, an idea that the White House and the Senate support as a tool to hold down medical costs but that labor unions are determined to fend off.

How Ms. Pelosi will play her cards in the conference is impossible to predict, her allies say. But Representative Anna G. Eshoo, a fellow California Democrat who is a close friend, said the speaker had so far sought to represent her caucus, not merely advance her own views.

“This is not Nancy Pelosi’s bill,” Ms. Eshoo said. “She does not go out and make pronouncements about what she wants for herself and hope that others will fall in line behind her. She speaks for the majority of the caucus when she makes those pronouncements.”

And, Ms. Eshoo said, Ms. Pelosi is equally mindful of protecting her members running for re-election in conservative districts, in part because she worked so hard to get them into office.

“She is not an executioner,” Ms. Eshoo said. “She is a winner.”

Ron Nixon contributed reporting.

A version of this article appears in print on November 7, 2009, on Page A14 of the New York edition with the headline: Fund-Raising Adds to the Competing Health Care Pressures on Pelosi. Order Reprints|Today's Paper|Subscribe